October 2016
Toxin Build Up in Firefighting Operations
By David Bullard, Columbia County Fire Department, and
Darlene Bartlett, Risk Manager, Columbia County
Ever yone is v ulnerable to a workplace hazard and
firefighters are at a particularly high risk by the very
nature of the work they are expected to perform.
To some this is a known realit y, but to many this
goes against the bulletproof mindset, and they simply
choose to ig nore ha za rd s wh ich may be cost i ng
firefighters’ lives.
Some hazards are being successfully reduced as personal
protective equipment for the fire service has evolved
greatly over the past three decades. The gear firefighters
wear has become much better at protecting them from
harmful atmospheres in building fires, reducing heat
stress, and protecting from other injuries. However,
more improvement is still needed – heat stress is still
important and a problem, due to the cardiovascular
strain and exertion from wearing the ensemble.
Add it ion a l ly, ot her r i sk s a re p erh aps not b ei ng
adequately addressed. Over the past several years,
studies and research have shown an upward trend
in cancer rates in the fire service. These are rated as
much as 150% to 200% higher than a firefighter’s peers.
Also, these cancers are appearing at a younger age than
in the general population. This is the issue that I would
like to address in this article, and provide information
and suggestions to assist in reversing this trend.
A bit of histor y is warranted first, to explain why
some practices exist that aren’t necessarily the best.
In the 1960s and 1970s, self-contained breathing
apparatus became available to the fire service. This
equipment was uncomfortable to wear and expensive
to purchase; often getting a refill for the air cylinders
cost money or was very time consuming. These factors
and a sometimes macho attitude did not aid in adding
effective respiratory protection for the fire service.
As a result, the breathing apparatus was only used
as long as absolutely necessary.As soon as the bulk
of the fire was extinguished, it was very common for
firefighters to remove their SCBA mask and work with
no respiratory protection. They weren’t ignorant; this
was just accepted as the norm. They were doing things
as it had always been done and as they were taught.
This practice still persists in some areas today.
T h i s s e c o n d a r y p h a s e o f f i r e f i g ht i n g – c a l l e d
overhaul – consists of opening walls and ceilings
to locate h idden f i re, ex t i ng u i sh i ng
smoldering f uels, and remov ing
burned materia ls from the
interior of the building.
Unfortunately, the contents and
materials in residences have changed dramatically over
the years. Furniture and home décor went from natural
materials and solid wood to pressed wood, synthetics,
and polymer-based components. When these fuels
break down during a fire and while smoldering, the
number of toxic gases produced is numerous. Carbon
monoxide, hydrogen cyanide, benzene, acrolein, and
halogens are just a few. All smoke encountered at fires
contains, at a minimum, nine class 1 carcinogens.
Also, the toxins in soot and ash produced by these
f uels can be absorbed through the sk in. Work ing
in this environment without appropriate protective
gear, including respiratory protection, may subject
firefighters to toxic exposure levels.
stop, to encourage a change of habits. Unfortunately
though, some firefighters see dirty unwashed gear as
a badge of honor and sooty faces as a sign of being
a ha rd worker. Th i s i s pa r t of a cu lt u ra l cha nge
that will need to occur. An anonymous survey in a
larger county department in the state netted some
interesting results.
Let’s review the products of combustion and their
effects on the body. The things that cannot be seen,
carbon monoxide and hydrogen cyanide, are the major
players in smoke inhalation injuries and deaths in
civilian fire victims. A firefighter not wearing an SCBA
during fire attack or overhaul is being exposed to both
of these gases, among many others. These things that
cannot be seen tend to do acute damage. If you talk to
firefighters who have performed overhaul or even fire
attack without respiratory protection, they will often
report having a headache the next day or even having a
feeling similar to a hangover.
• 90% were less than diligent about washing their
gear after contamination.
The products of combustion that can be seen, like
soot and ash, typically contribute to chronic or latent
problems such as ca ncer. If a f iref ig hter’s PPE is
not cleaned after becoming soiled, these materials
continue to be absorbed through the skin, leading
to an additive effect or possibly even a synergistic
ef fect as the materia ls combine. A lso, due to the
construction of firefighter PPE, currently there is no
way to prevent these solids from getting inside of the
gear. It is imperative that firefighters not only wash
their turnout gear, but also shower as soon as possible
and change their uniform or clothing worn under
their gear. Research has shown that the neck area is
the most absorbent on the body.This area is also the
least protected from soot and ash in the firefighter
PPE ensemble. (A portion of the PPE ensemble, called
a hood, covers the ears, scalp, throat, and neck. Hoods
are now being introduced that limit the amount of
contaminants reaching the skin, with a two to three
times increase in cost).
Popular culture has encouraged the viewpoint of the
dirty or “salty” firefighter. Most images today, even
those in fire service product ads, show firefighters
in dir t y gear, w ith soot-covered faces. There is a
commendable push in the fire service for this trend to
• 90% reported having a headache or “hangover”
feeling on the day after a fire, to include black
soot-filled phlegm.
• 50% to 60% have never washed their turnout gear
in the last year (NFPA recommends a minimum
of every six months).
The fire ser vice has a tradition of cleanliness for
apparatus and stations. This tradition can be used to
help educate about the importance of cleanliness for
PPE and yourself. Exposures cannot be eliminated,
but they can be reduced. A lot of departments have
washer extractors, but for some this is cost prohibitive.
Other agencies have been able to fund a second set
of PPE, so that a dirty set can be swapped out after
a fire. Unfortunately, for many places this is also
cost prohibitive.
Ma ny yea rs of resea rch a re a head to deter m i ne
changes to PPE to better prevent these hazards. In the
meantime, some best practices can be adopted and
encouraged to reduce the potential impact of them.
With knowledge comes the power to solve.
A list of best practices and items to address within
your agencies would include:
• Store gear outside of the apparatus bay, especially
if vehicle exhaust systems are not utilized.
• Do not run apparatus or small engines in the bay
if at all possible.
• E n c o u r a ge c a n c e r s c r e e n i n g s ; s o m e l o c a l
healthcare systems may assist with this free of
charge.
• If you prov ide wellness checks or physica ls,
educate t he physicia n on t he a spec t s of
firefighter cardiovascular health and the risks
of c a ncer. I f you do not prov ide phy sic a l s,
enc ou r a ge you r dep a r t ment ’s mem b er s t o
educate their personal physician on these same
hazards of firefighting.
• Ban firefighter PPE from all living areas of the
fire stations. If it is to be used in a classroom
setting, it should be clean first.
visible smoke is gone, then air monitoring can be
used to determine SCBA use. If air monitoring is
not available, then SCBA must be used.
• Set policies or guidelines to decontaminate
f iref ig hter PPE whi le on scene. This can be
performed w ith a scrub brush, dish soap or
simple green, and a garden hose. Dirt y gear
should be removed while wearing medical gloves.
Use wet wipes to wipe inside of SCBA mask and
inside of helmet as well.
• Develop a firefighter specific health and wellness
p r o g r a m , w i t h a fo c u s o n c a r d i o v a s c u l a r
conditioning.
• S e t p o l i c e s a b o u t d e p a r t m e n t m e m b e r s
taking their gear into their own home. If it is
transported by personal vehicle, require that all
possible steps to reduce contamination are taken.
• A f ter a f ire, f iref ig hters shou ld shower a nd
cha nge u n i form s a s soon a s possible.These
showers should be at least five minutes in the
warmest water that the firefighter can stand.
The soap used should not contain moisturizers.
For off duty or volunteer firefighters, encourage
carrying an extra set of clothes they can change
into before going home.
• When firefighters go to a rehab area at a fire
scene, their PPE should be removed. Studies
have shown that it offgases for up to 45 minutes.
Anytime decon of the gear is not possible, the
gear should be allowed to air out for at least
45 minutes.
• W hen firefighters go to rehab, provide some
form of wipe for them to clean their hands, face,
and neck area before drinking or eating.
• Consider a program where all firefighter hoods
are exchanged on the scene of a fire for clean
ones. The dirty ones can be washed as a lot and
become the spares for the next incident.
• Encourage washing of firefighter PPE (head
to toe) and SCBA based on manufacturer’s
recommendations after becoming soiled. If
your agency does not have a washer extractor,
check with surrounding jurisdictions that you
could possibly partner with.
• Wo r k t o w a r d a n a b i l i t y t o p e r f o r m a i r
mon itoring on t he f ire ground for ca rbon
monoxide and hydrogen cyanide.
• Set policy for mandatory SCBA use throughout
fire attack and overhaul at structure fires,
vehicle fires, and dumpster fires. As long as
visible smoke is present, SCBA is to be used. Once
• Set policy requiring that chief officers and fire
investigators (if your agency has them) wear
appropriate sk in and respirator y protection
while investigating, post fire.
• Encourage the washing of dirt y uniforms or
clothing worn under turnout gear, at the fire
station.
• Utilize a turnout gear inspection program based
on NFPA 1851.
Understandably, change will not happen overnight. We
first have to recognize that there is a problem and then
we can work together to address the issues and move
forward, doing what we can to protect our employees
while still equipping them to effectively perform their
jobs. Enforcement of policy alone will not be a suitable
solution. Education at supervisory level and individual
level will be key. There may well be other practices
and recommendations that would also address these
hazards.If so, hopefully this can open up a dialogue to
share best practices so that we can keep our employees
healthy and safe today, tomorrow and even years down
the road.
Local Government
Risk Management Services
PRSRT STD
U.S. POSTAGE PAID
ATLANTA, GA
PERMIT NO. 3259
3500 Parkway Lane • Suite 110
Norcross, Georgia 30092
A Service Organization of the Association County Commissioners of Georgia and the Georgia Municipal Association
This Month:
Toxin Build-Up in FIrefighting